Overview

Nongonococcal Urethritis: Treatment, Procedure, Cost and Side Effects

What is the treatment?

Urethritis is the inflammation of the urethra (the tube which runs from the bladder to the penis in males and the labia in females through which the urine discharges) due to bacterial conditions. On the other hand, nongonococcal urethritis is known as the infection of the urethra that is not caused by gonorrhea. This infection is caused due to multiple different organisms. Frequently, a germ called Chlamydia, which is a sexually transmitted disease (STD) is the source. It is mostly found in men, the reason being that this infection is caused due to sexual transmission and females during intercourse are seldom infected.

If nongonococcal urethritis is suspected a person need to take a few tests. Even if the symptoms go away after a point, he needs to reassure whether there is anything still wrong or not. A local genitourinary clinic (GUM) will carry out all the tests needed. A urine specimen must be provided to identify the cause. There may also be a requirement of a tiny swab (sample) from the blood tests. Medications like antibiotics usually clear the infection. The antibiotics prescribed are usually dependent on germs (bacteria) like Chlamydia or conditions when other infections are also present. Even if there are no bacteria found after tests, the individual may still be suggested to take antibiotics if he has shown the symptoms. Antibiotic treatment will more likely make a person better if taken in a continuous course and completed properly.

How is the treatment done?

Firstly, men with urethral symptoms must be examined for urethral discharge, ulcers, or inguinal lymphadenopathy. Serial palpation should be used to gently ‘’milk’’ the urethra down the penis shaft towards the urethra. Currently, urethritis is tested by a positive leukocyte esterase test result in first-void urine. In case there is no discharge present, first-void urine should be examined to document pyuria. A DNA test for Chlamydia is also recommended. The doctor does a digital rectal examination of the prostate.

Patients with confirmed nongonococcal urethritis receive the primary treatment of a combination of 100 mg of oral doxycycline (for chlamydia) or a single 1-g dose of oral azitrhomycin (Zithromax) twice per day for a week. Both of these medications have similar cure rate. It is a possibility that doxycline has a higher clearance rate than azithromycin. There has been a caution expressed by doctors about single-doze azithromycin 1g involving macrolide resistance in genitalium, despite compliance and successful treatment cases of nongonococcal urethritis in which the test results are mostly negative for Chlamydia, ureaplasma and mycoplasma species. Because of the concern for induced macrolide resistance of genitalium after the intake of single-dose azithromycin 1g, some doctors recommend treatment of doxycycline 100 mg orally a couple of times, per day for a week.

Who is eligible for the treatment? (When is the treatment done?)

Patients who haven’t used antibiotics in the past month are eligible for the treatment. Also, patients with chlamydial infections (detected by urine assay) are included.

Who is not eligible for the treatment?

Patients who have taken antibiotics in the previous month are ineligible for treatment. Also, patients with gonococcal infections (detected by urine assay) are precluded from receiving the treatment.

Are there any side effects?

The side effects of the antibiotics include nausea, diarrhea, vomiting, stomach ache and many more.

What are the post-treatment guidelines?

A healthcare professional or a doctor will need to know regularly if the treatment has worked or not. It is normal to be reviewed two or three weeks after the treatment has been started on a patient, to keep a check on the symptoms. Once in a while, re-testing and a second anti-toxin medication are needed if the symptoms or side effects persist. A patient must wear a condom during anal or oral sex as it prevents the spreading of STIs (sexually transmitted infection). The risk associated with STIs increase with multiple changes of sexual partner. After ruling out all the infections, the doctors suggest the patients to use lubricants, fragrance-free soaps, and other products. Carbonated beverages should be avoided and water intake should be increased. Discontinuation of spermicide use is necessary.

How long does it take to recover?

It takes about 2 weeks to recover from nongonococcal urethritis. In case a patient doesn’t get better by then, he should return to the sexual health clinic and be given a new drug prescription.

What is the price of the treatment in India?

The price of treatment ranges between Rs. 2,828 to Rs. 5,000.

Are the results of the treatment permanent?

The results of the treatment are not permanent as a person with untreated nongonococcal urethritis can pass the infection to the previously infected person again.

What are the alternatives to the treatment?

It is necessary for a patient to include garlic in his meals as garlic cloves are rich in anti-microbial agents like allacin. In order for the body to fight infection a garlic tonic must be prepared and had every day. Chopping and mashing two or three pods of garlic, putting it in a glass of boiling water and having it daily will help rule out the infection.

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MBBS Bachelor of Medicine and Bachelor of Surgery, Fellow of The Royal Society of Health, Certification In Sexologist

Sexologist, Delhi

Chlamydia is caused by the bacteria Chlamydia trachomatis and doesn't have any defined symptoms and hence, most people who suffer from it are not even aware of their status. Of all the sexually transmitted diseases, Chlamydia is the most common. And, since it doesn't have any defined symptoms, it is transmitted unknowingly from one person to another. Chlamydia can also be passed on from mother to child, if the mother suffers from Chlamydia while she is pregnant. Here are a few things you should know about this sexually transmitted disease. Symptoms: Symptoms of Chlamydia are noticeable within 1-3 weeks of unprotected intercourse. The symptoms of Chlamydia are different in men and women. Symptoms in Men Clear or cloudy discharge from the penis Painful urination Burning and itching around the penis head Painful swelling of the testicles Symptoms in Women Abnormal vaginal discharge Painful menstruation Bleeding between menstrual cycles Abdominal pain and fever Painful urination Itching and burning around vagina Pain during intercourse A simple urine test or lab test can be used to diagnose Chlamydia. For the lab test, the doctor will take a sample swab from a man's urethra or a woman's cervix. Once diagnosed, Chlamydia can be easily treated. In most cases, oral antibiotics will cure the patient in a week or two. It is important to complete the antibiotic course even if the symptoms disappear early. In some cases, women with severe Chlamydia may need to be hospitalized for intravenous treatment. With Chlamydia, it is important not only for you to get yourself treated, but to also get your partner treated. This will eliminate the chances of the disease recurring. You must also test yourself after three months to ensure that the disease has been completely cured. Chlamydia can affect your health badly, if left untreated. It can cause pelvic inflammatory disease in women, which may make the woman infertile by affecting her fallopian tubes. It could also increase the risk of an ectopic pregnancy and premature birth. Further, remember that Chlamydia can also be passed on from mother to child if left untreated. This can cause the newborn to have an eye infection or pneumonia at the time of birth. If left untreated in men, Chlamydia can cause nongonococcal urethritis, epididymitis and proctitis. The first is an infection of the urethra; the second, an infection of the tube that carries the sperm from the testis and the third is an inflammation of the rectum. Like all STDs, Chlamydia can be prevented by the use of a condom and fidelity between sexual partners.

Dyspareunia is pain prior to, during, or after, sexual intercourse. Dyspareunia is more common in women but can affect either sex. Dyspareunia can have several different causes. For instance, vaginismus is a spasm or contractions of the muscles surrounding the vagina. Dyspareunia is pain prior to, during, or after, sexual intercourse. Dyspareunia is more common in women but can affect either sex. Many women will experience dyspareunia at some time in their life. Sometimes a medial or physical etiology may not be obvious and psychosocial factors also can play an important role. In men, dyspareunia can be related to an allergic reaction to a condom or spermicidal. An infection of the prostate or prostatitis may also cause pain. If a female partner has a vaginal infection or dryness, the male can experience discomfort during intercourse. Dyspareunia can have several different causes. For instance, vaginismus is a spasm or contractions of the muscles surrounding the vagina. Women with vaginismus have pain with insertion of tampons as well as with penile penetration. Vulvodynia and vulvar vestibullitis are both conditions that are characterized by painful intercourses. They are also characterized by vulvar burning and itching. The discomfort may not necessarily be associated with intercourse. In older women vaginal dryness is a common cause of dyspareunia. This is a common problem for women that are not on hormone replacement. Dyspareunia can also be caused by abnormalities of the uterus or pelvic organs. Woman may describe the pain as feeling that something is being pushed or bumped during intercourse. An enlarged uterus or ovary can cause painful intercourse especially during deep penetration. A prolapsed or dropped uterus or bladder may also cause discomfort. Dyspareunia can also result from previous pelvic surgery or infection. These conditions can reduce movement of the pelvic organs resulting in pain with deep penetration. Women who experience trauma such as rape or sexual assault may also experience dyspareunia. Unfortunately, many women may have difficulty sharing this information with their health care providers. In order to treat dyspareunia appropriately the cause must be identified. The time at which the pain occurs during intercourse and other associated symptoms can help determine the potential etiology. For instance, pain during entry may have a different etiology than pain with deep penetration. It is also important for a health care provider to know when in a woman s life symptoms began. For example, if a woman s symptoms began around or shortly after menopause; her symptoms could result from atrophic vaginal tissue. She may describe her symptoms as burning or friction with intercourse. Vaginal lubricants or estrogen can improve dryness and decrease pain. For women with a history of endometriosis, pelvic surgery, or infection, treatment of dyspareunia is aimed at restoring pelvic organs to their normal positions and reducing scar tissue. Surgical management may also be recommended for women with symptomatic prolapsed of the uterus, rectum, or bladder. Women with a history of sexual abuse or treatment may benefit from psychological evaluation and treating any depressive symptoms that are present. Types of dyspareunia: It is useful to differentiate between the different types of dyspareunia to arrive at the appropriate diagnosis, treatment, and eventual prognosis. 1. Superficial dyspareunia. Vaginismus is a specific type of dyspareunia that refers to spasms of the levator ani and perineal muscles, making intercourse difficult, painful. Undesirable, and often impossible. May clinicians have defined vaginismus as an almost certain psychogenic illness. However, organic disorders of the external genitalia and introital areas can cause such severe discomfort that any attempts at penetration can leas to spasm. This particular cycle, primarily caused by situational and anticipatory anxiety, can become self perpetuating often both organic and functional and can be solely a result of recognized disease entities. 2. Deep dyspareunia refers to a deeper pelvic pain that is experienced at any time during intercourse. Again, this may be secondary to pelvic abnormality, or it may be functional in origin. It also tends to overlap more with chronic pelvic pain syndrome. Etiology of dyspareunia: The presence of organic disease is often the cause of dyspareunia. Virtually all gynecologic disease entities list dyspareunia as a possible symptom. Prominent in the list of diseases associated with dyspareunia are the following: Chronic pelvic infection. Endometriosis Pelvic carcinoma Extensive prolapsed or organ displacement Episiotomy. Acute vulvovaginitis Cystitis Urethral syndrome or other urinary tract disorders. Introital, vaginal, and cervical scarring. All space occupying lesions. Levator ani myalgia. Vulvar vestibulitis. 1. As with chronic pelvic pain syndromes, gastrointestinal (gi) diseases (e. G, bowel motility disorders) must be excluded. 2. Estrogen deprivation, irritating vaginal medications, sympathomimetic drugs, amphetamines, and cocaine are also causes, primarily in superficial dyspareunia and vaginismus. 3. The most common causes of superficial dyspareunia include vaginitis (atrophic or infectious) or lack of lubrication (either caused by physiologic conditions or suboptimal sexual technique. 4. Lesions in the cul-de-sac are said to correlate most often with deep penetration dyspareunia. 5. Women who have deep penetration dyspareunia and who do not have superficial pain on penetration or vaginismus usually do not have a causative external inflammatory syndrome. 6. Some individual with external dyspareunia or vaginismus have small, almost imperceptible scar tissue secondary to surgery or childbirth. 7. Two clinical syndromes not usually recognized involve broad ligament varicosities and the broad ligament tear syndrome. 8. Frequently unrecognized etiology, particularly on first, interview, is a history or sexual assault or abuse. Diagnostic workgroup It is extremely important to look for evidence of sexual abuse both on history and physical examination before undertaking an expensive workup. Routine studies include a cbc, sedimentation rate, urinalysis, urine culture and sensitivity, and vaginal smear and culture. A pap smear should also be done. If pregnancy is suspected, a pregnancy test should be done. If there is a pelvic mass, pelvic ultrasound may be helpful. A referral to gynecologist is usually made before ordering this study, however. If vulval dystrophy is suspected, a vaginal biopsy may be useful. If the vaginal examination is normal, perhaps a psychiatrist should be consulted. Normal pelvic examination Abnormal pelvic examination Difficult penetration Difficult during intercourse With abnormal rectal examination Inflamed Hymeneal Orifice Bartholinitis Vulvitis Vulval Dystrophy Cystitis Urethritis Difficult during intercourse Salpingooophoritis Retroverted Uterus Endometriosis Ovarian cyst. With abnormal rectal examination Hemorrhoids Anal fissure Impacted Feces B-normal pelvic examination With sexual desire 2. Without sexual desire Functional dyspareunia not true dyspareunia Differential diagnosis Sexual pain disorder: persistent recurrent genital pain or nonorganic cause associated with sexual stimulation. Vaginismus: painful, involuntary spasm of the vagina, preventing intercourse Vulvar vestibulitis: a chronic and persistent clinical syndrome characterized by severe pain with vestibular touch or attempted vaginal entry, tenderness in response to pressure within the vulvar vestibule, and physical findings confined to various degrees of vestibular erythema. Vulvodynia: chronic vulvar discomfort (e. G. Burning, stinging, irritation, rawness). Female sexual dysfunction (disorders of desire, arousal, or orgasm) Homeopathic remedies. 1. Bellis perennis Bruised sensation in the vagina, if intercourse is interrupted. 2. Cactus grandiflora Vagina squeezes shut when intercourse is attempted. Intercourse may be easier just before menses. 3. Coffea Over sensitivity of the vulva and vagina. Heat and itchiness. Vaginismus with pain. 4. Cuprum Cramping in the vagina and sometimes also in the legs, during intercourse. 5. Ferrum Vagina feels dry, painful and raw. No feelings of arousal. 6. Gelsemium Anxiety before intercourse. Tendency to vaginismus. 7. Lycopodium Dry, burning vagina during and after intercourse. May have varicose veins in vulva. 8. Natrum mur Dryness, with smarting and burning pains. Acrid discharge. 9. Platina Strong sexual desire. May have erotic dreams. Difficult to have intercourse as vulva is extremely over-sensitive. Intercourse is painful and causes bruised sensation. 10. Rhus tox Soreness during and after intercourse, often accompanied by physical restlessness. 11. Sepia Dryness with bleeding after intercourse. (if you have this symptom seek medical advice.) feeling that everything will prolapse. Suits women who are exhausted and want to escape from their situation. 12. Staphisagria Extremely useful remedy for pain after loss of virginity or in instances of rape or sexual assault. 13. Thuja Vagina is over-sensitive making intercourse painful and difficult. Pains: burning, sore, bruised. May be helpful where there is a history of sti s or if there are feelings of shame and self-disgust in relation to intercourse. But before taking these medicine please consult your homoeopathic doctor.

Burning urination or painful urination is also called dysuria, and it is one of the most common complaints amongst women. Another common problem is frequent urination. What are the causes of these two conditions? Are they in fact related? Frequent urination, in simple terms, is also sometimes called overactive bladder and it is the need to urinate more than you normally would. This can cause loss of bladder control too. You may feel extremely full even after using the toilet and the feeling is extremely uncomfortable. Medical practitioners bracket urinating every two hours or more as frequent urination. Some of the underlying causes are A urinary tract infection or UTI is the most common cause of frequent urination. UTIs happen when bacteria enters your urinary bladder through the urethra. Men also get UTIs, but it is less common than women as the ladies have shorter urethras. This means that bacteria have less distance to travel before they can infect the urinary tract causing UTIs. UTIs in women can be prevented by proper wiping after using the toilet, which will protect the urethra from E.coli bacteria. Proper hygiene also is a deterrent, especially after intercourse. Medical conditions affecting muscles, nerves, and tissues. Weakening of nerves due to hernias in the lower back etc. can also cause an overactive bladder. Oestrogen deficiency caused due to menopause can cause an overactive bladder and a woman finds it difficult to hold the urine for long. Obesity can also place extra pressure on the bladder. Burning sensation while urinating Common reasons behind it Frequent urination does not point to any gynaecological issues but burning urination is a common symptom of sexually transmitted diseases or STDs like Chlamydia and Gonorrhea which cause symptoms like pain when urinating and vaginal discharge. Burning urination usually occurs after intercourse when sexually transmitted infections are present. Burning while urination can also be caused due to UTIs and it is often accompanied by other symptoms of UTIs like painful urination or dysuria or blood in the urine. Kidney stones are solid masses of crystalized calcium or other materials that start in the kidneys but can pass through the urinary tract causing pain and discomfort. Urethral stricture is a condition when the urethra narrows and this causes burning and pain during urination in women. Urethritis is the inflammation of the urethra in women can cause burning on urination. Pelvic inflammatory disease is an infection of the reproductive organs in women and causes abdominal pain especially during urination or sex. Bladder cancer Vulvovaginitis is a common infection of the vulva and vagina, both, and it causes burning and itching while urinating and increased vaginal discharge.

Penis Pain Quiz: Causes and Symptoms Since the penis is a very sensitive organ, penis pain can have a disproportionate effect on a man. Avoiding penis pain is a must, but there can be many causes of that pain - and sometimes it's not always obvious what the most likely cause is. (Indeed, sometimes a visit to the doctor is needed to get a definite answer on the cause and to determine appropriate treatment.) Maintaining good penis health is one way to avoid the likelihood of penis pain - and the following quiz can provide tips on how to narrow down the possible causes of that pain. Below are a number of scenarios that involve manhood pain. Each scenario is followed by three possible causes. Pick the one that seems the most likely cause, based on the information given. Scenario #1 John has noticed that his penis is slightly swollen and tender. When he was masturbating recently, his ejaculation was accompanied by pain. When he has urinated lately, there's been a distinct burning sensation, and his urine has had a pinkish color to it. Which of the following is the likely cause of John's penis pain? 1. Peyronie's disease 2. Urethritis 3. Excessive masturbation Answer: B. Urethritis. The urethra, which carries urine from the body, can get inflamed and swollen due to bacteria or viruses. Sometimes urethritis may be caused by chlamydia or gonorrhea. Generally, it's a painful situation. Scenario #2 Mike was enjoying a robust bout of intercourse with his girlfriend. Things got a little frenzied and at one point, Mike thrust very powerfully at an unusual angle. He heard a popping sound and then experienced intense pain in his penis. He ceased coupling, but the pain continued to be quite intense. His penis remained swollen and was bruised. Which of the following is the likely cause of Mike's pain? 1. Peyronie's disease 2. Chlamydia 3. Penis fracture Answer: C. Penis fracture Penis fractures are fortunately very rare, but they do occur. The most common cause is similar to that described above: the penis, usually erect, meets a hard surface at an unaccommodating angle. It is important to seek immediate medical attention if a penis fracture is suspected. If a fracture is left untreated, it can have an impact on erectile function; often that impact is permanent. Scenario #3 Sam, whose penis is intact, noticed that the glans was becoming noticeably swollen and red. There was a rash in the area, and a discharge that had a foul odor to it. The swelling made it hard for his foreskin to retract, and there was a tenderness to the glans which made it quite sensitive. Which of the following is the likely cause of Sam's issue? 1. Erectile dysfunction 2. Balanitis 3. Priapism Answer: B. Balanitis Balanitis is a fairly common issue, more often found in intact men than in circumcised ones. The condition may simply indicate a need to more thoroughly clean the affected area, but in other cases something else (e.g., infection, reaction to harsh soaps, etc.) may be responsible. Often, penis pain is related to everyday causes involving proper penis health care. Daily use of a top-notch penis health creme (health professionals recommend Man1 Man Oil) can be a big help here. When selecting the proper cr me, a man should look for one that includes a potent antioxidant, such as alpha lipoic acid. Such an antioxidant helps to offset harmful oxidative stress in penile cell metabolism, keeping the penis in better shape. For that same reason, a cr me with vitamin C is also recommended. Vitamin C is an important structural component of blood vessels and aids significantly in collagen production. Both of these factors help with overall penis health, making it a stronger organ that looks and feels better.

Chlamydia is caused by the bacteria Chlamydia trachomatis and doesn't have any defined symptoms and hence, most people who suffer from it are not even aware of their status. Of all the sexually transmitted diseases, Chlamydia is the most common. And, since it doesn't have any defined symptoms, it is transmitted unknowingly from one person to another. Chlamydia can also be passed on from mother to child, if the mother suffers from Chlamydia while she is pregnant. Here are a few things you should know about this sexually transmitted disease. Symptoms: Symptoms of Chlamydia are noticeable within 1-3 weeks of unprotected intercourse. The symptoms of Chlamydia are different in men and women. Symptoms in Men Clear or cloudy discharge from the penis Painful urination Burning and itching around the penis head Painful swelling of the testicles Symptoms in Women Abnormal vaginal discharge Painful menstruation Bleeding between menstrual cycles Abdominal pain and fever Painful urination Itching and burning around vagina Pain during intercourse A simple urine test or lab test can be used to diagnose Chlamydia. For the lab test, the doctor will take a sample swab from a man's urethra or a woman's cervix. Once diagnosed, Chlamydia can be easily treated. In most cases, oral antibiotics will cure the patient in a week or two. It is important to complete the antibiotic course even if the symptoms disappear early. In some cases, women with severe Chlamydia may need to be hospitalized for intravenous treatment. With Chlamydia, it is important not only for you to get yourself treated, but to also get your partner treated. This will eliminate the chances of the disease recurring. You must also test yourself after three months to ensure that the disease has been completely cured. Chlamydia can affect your health badly, if left untreated. It can cause pelvic inflammatory disease in women, which may make the woman infertile by affecting her fallopian tubes. It could also increase the risk of an ectopic pregnancy and premature birth. Further, remember that Chlamydia can also be passed on from mother to child if left untreated. This can cause the newborn to have an eye infection or pneumonia at the time of birth. If left untreated in men, Chlamydia can cause nongonococcal urethritis, epididymitis and proctitis. The first is an infection of the urethra; the second, an infection of the tube that carries the sperm from the testis and the third is an inflammation of the rectum. Like all STDs, Chlamydia can be prevented by the use of a condom and fidelity between sexual partners.

Penile burning sensation is a feeling of burning, redness, warmth or swelling in the genitals, particularly in the penis. The sensation can be accompanied by blisters, pain, bloody or pink-colored urine (hematuria), itching, peeling, rash, scabbing, or swelling. Penile burning sensation can be extremely uncomfortable and create difficulty with urination, sexual relations, and daily activities. In addition to symptoms in and around your penis, it can be accompanied by generalized symptoms, such as flu-like symptoms (fatigue, fever, sore throat, headache, cough, aches and pains) and poor health in general.
Urethritis is the medical terms for inflammation of the urethra, which is a common cause of penile burning sensation. Cystitis (inflammation of the bladder) or prostatitis (prostate inflammation) can also be associated with a burning sensation in the genitals. Sexually transmitted diseases are examples of infections that can cause penile burning sensation. These diseases include herpes, genital warts (human papillomavirus infection), syphilis (sexually transmitted disease caused by bacteria), chlamydia, or gonorrhea.
Other causes of burning in penis are- Allergies
Balanitis (inflammation of the foreskin)
Contact with irritants such as soap or detergents
Dermatitis
Diabetes Lichen sclerosis (chronic inflammatory skin condition)
you need to consult a good doctor for this problem so that the above mentioned conditions is to be ruled out as soon as possible and proper treatment is to be started.

Hello-
Standardized cranberry extracts may improve the health of your kidneys, while green tea possesses strong antioxidant and immune-enhancing effects. Cat's claw possesses antibacterial and anti-fungal action, while uva ursi, or upland cranberry, and bromelain may treat urethritis. These herbs should be used in conjunction with conventional treatment methods for urethritis.

Hi Uddipan,
It is Urethritis not arthritis. It means inflammation of urethra it can be easily solved need some history.
For that avoid spicy and fried food .Take milk two times a day. Take curd in noon hours. No it will not harm your sexual life but should be treated early.